Complex regional pain syndrome.

Abstract Complex regional pain syndrome remains an enigmatic condition to manage due to its diverse etiology, varying clinical course, and lack of definitive treatments that are universally effective. Though there continues to be debate with regards to the pathophysiology of CRPS, significant advances have been made in gaining deeper understanding of the peripheral and central pathophysiological mechanisms governing the development and elaboration of CRPS. The conceptual framework focuses on the neurobiological changes occurring peripherally and centrally and has enabled examination of linkages between changes in cutaneous innervation, release of inflammatory mediators, peripheral sensitization, involvement of the sympathetic system, and resultant central sensitization with cortical reorganization. These advances necessarily precede the much needed innovation in available treatment modalities. The current paradigm centers on a multimodal pharmacologic therapy in the setting of a comprehensive multidisciplinary team-based approach aimed at effective pain control, functional restoration, and modalities to enhance psychological well-being as important components of care. The use of other potential therapies aimed at the immunological/inflammatory basis of CRPS, including naltrexone (a glial cell modulator), and immunoglobulin IV are also considered in this chapter. Finally the role of neuromodulation (spinal cord stimulation) and possible use of intrathecal baclofen for refractory dystonia are addressed as options for appropriately selected patients.